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General NPI Number Information
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NPI Number | 1225239445
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Entity Type | Individual
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Provider Name | MARTIN VANDORT
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 2314 SASSAFRAS ST 2ND FL
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City | ERIE
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State | PA
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Zip | 16502-2721
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Country | US
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Telephone | 814-456-6194
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Fax | 814-452-5777
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Provider Business Mailing Address
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Address Line | 2314 SASSAFRAS ST 2ND FL
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City | ERIE
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State | PA
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Zip | 16502-2721
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Country | US
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Telephone | 814-456-6194
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Fax | 814-452-5777
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | MD431739
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License Number State | PA
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